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Flashcards in Exam 3 Deck (51):
1

Inflammation

an immunologic defense against tissue injury, infection, or allergy

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First outcome

Involves acute inflammation and restitution
Best possible outcome
(ex-sprained ankle)

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Acute inflammation

initial response to injury
Focus is to eradicate dead tissue and protect against infection

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Restitution

damaged tissue is replaced by identical tissue

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Second outcome

fibrous repair of the damaged tissue and formation of scar tissue
Substantial tissue damage (ex-burn)

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Third outcome

development of chronic inflammation;
pathologic agent remains active;
tissue destruction continues;
high outcome of morbidity and mortality

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Fourth outcome

death of tissue and death of host
worst possible outcome

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What are the outward signs of acute inflammation?

5 cardinal signs:
redness, swelling, heat, pain, loss of function

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Physiologic changes of acute inflammation

increased blood flow;
migration of leukocytes from the blood to the tissues;
proteins, fluids, lymphocytes, monocytes, macrophages, granulocytes

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Chronic inflammation

continues for weeks to years, never really goes away;
a granuloma is formed

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Granuloma

at the site of an injury: an accumulation of macrophages, fibroblasts and collagen

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Important history to assess for inflammation?

What was the trigger?
-exposure to allergens
-exposure to infectious agents
-recent injury
Risk factors: very young, very old, immunocompromised
Physiological ability to respond
Symptoms and duration
Treatment up to the point of diagnosis

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Internal signs of inflammation

fever, increased WBC, slowing/absence of tissue/organ function

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Labs for inflammation

WBC with differential
C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)

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C-reactive protein (CRP)

elevation tells us that there is presence of inflammation;
marker for cardiac disease

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Erythrocyte sedimentation rate (ESR)

refereed to as esedrate;
elevation indicates presence of inflammation

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Epstein-Barr

virus that causes mononutriosis

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C-diff

3 loose stools confirm presence;
needs protective isolation

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H.pylori

microorganism;
antibiotic 7-10 days and ulcer is gone

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Primary prevention of inflammation

hand hygiene, clean wounds, safety equipment in sports (helmets, padding), food and water safety standards

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What does RICE stand for? (used for sprains)

Rest
Ice
Compression
Elevation

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Steroid usage in inflammation

effective in reducing swelling and pain

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NSAIDs in inflammation

good for pain, fever, and inflammation

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Antipyretics in inflammation

for fever (103 or higher, get blood culture)

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Analgesics in inflammation

for pain

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Antimicrobials in inflammation

for actual microorganisms or prophylaxis

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Evidence definition

an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities that are served

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Primary literature involves

quantitative research, qualitative research, and mixed design research
(original research)

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Quantitative research includes:

objective observation and validation;
random controlled double blind studies

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objective observation and validation

forms hypothesis of what the researcher is trying to prove

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random controlled double blind studies

least amount of bias;
two groups: controlled and experimental;
both patients and researchers are blind to interventions

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Qualitative research includes:

a person'ts experiences, interviews, surveys, questionaires

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Mixed design research

a combination of both qualitative and quantitative research;
provides a holistic approach to research questions

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Secondary literature involves

evidence summaries, and systematic reviews/meta-analysis

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Evidence summaries

summarizes original research studies

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Systematic reviews/meta-analysis

synthesis of the evidence and conclusion on effectiveness;
summarizes evidence from multiple studies

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Attributes of evidence

has to have:
-replicability
-reliability
-validity

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GRADE system

Grades of recommendation assessment, development, and evaluation

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Grade A

Strongly recommends: high certainty that net benefit is substancial

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Grade B

Recommends: high certainty that the net benefit is moderate to substancial

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Grade C

Neutral: moderate certainty that the net benefit is small

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Grade D

Recommends against: moderate to high certainty that there is no net benefit OR that the harm to the patient outweighs the benefit

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Grade E or I

Insufficient evidence to recommend for or against

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Randomized controlled trial

test group and controlled group

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Cohort study

research following one group of people

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Case-controlled study

study of two groups that have two different outcomes

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Case study/reports

detailed analysis of members o f a group and making inferences

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Longitudinal study

study over time

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Ethnography

study of people and cultures

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Phenomenology

study of experiences and consciousness as experienced from a 1st person point of view

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Grounded theory

discovery of theory through analysis of data